How a low-sodium diet increased one heart patient's quality of life

"The secret ingredient is salt," said a plastic-figurine Marge Simpson at the push of a button in my mom's Simpsons living-room diorama. (Marge was holding a tray of cookies she presumably had just made.) But for some congestive heart failure patients, the secret to recovery is not-salt.

I thought of Marge when reading a heartening piece in the recent issue of Inside Stanford Medicine. It tells the story of how patient Bruce Simon, after recovering from a heart attack and cardiothoracic surgery, adopted a low-sodium diet according to his doctors' recommendations and was able to avoid needing a heart transplant. By modifying his lifestyle as part of his health-improvement regimen he went from sleeping upright and wearing an oxygen mask to being able to walk two miles on a treadmill without becoming short of breath.

"A lot of people with heart failure come to a cardiologist's office and expect to get medications," said Simon's doctor, Dipanjan Banerjee, MD, clinical assistant professor of cardiovascular medicine and medical director of Stanford Hospital's Mechanical Circulatory Support Program. "Probably the most important thing we do in our clinic is focus on lifestyle and dietary changes. The cornerstone of our therapy for our congestive heart failure patients is sodium restriction."
...
Simon, who came to Stanford Hospital & Clinics to be evaluated for a heart transplant on the recommendation of his Montana doctors, performed just a little too well on the heart transplant evaluation tests, so Banerjee sat him down to talk about diet. Even though Simon did not have high blood pressure or high cholesterol — two key precursors of coronary artery disease — his heart was stressed by the effort needed to pump accumulated excess fluid. Sodium in excess puts more stress on the heart, Banerjee said, because it causes water retention, making the heart work harder to pump that extra fluid around the body. "For people who don't have congestive heart failure, reducing sodium is not as important," Banerjee said. "For a patient with congestive heart failure, low-sodium intake is crucial."

Rather than prescribe higher doses of diuretics to help rid Simon's body of excess fluid, Banerjee wanted him to try living by a simple rule that he often prescribes for his patients with heart failure: "Nothing out of a can, nothing out of a bag, nothing out of a box and no processed foods" is how Simon remembers it.

Simon said, "People tell me I don't even look like the same guy," he said. "I feel great, and I can do just about anything I want. Eating carrots and celery is a whole lot better than having a heart transplant."